she has too much time or money. It is psychological suffering that brings people to ask a plastic surgeon for help. Michelangelo said: “See the shape within the cries and smiles. Physical disorders, defects, or im-
perfections can be surgically improved on condition that our emotional costume is not damaged. Hardly
Fig. 9.1. a A 25-year-old person;
it helps us when our patients bring us their pictures of when they were young.
b Many plastic surgeons and their patients are very fond of the arts.
c Now, she is 50 years of age. d After minimal-invasive (MIDI) facelift and eyelid surgery, she looks some 12 years younger. Smiling lines on her cheeks should have been preserved
marble and release it!” Plastic surgery can release the patient from his/her complex. Today we can rectify Sigmund Freud, who stated: “Anatomy is destiny.” We are now able to influence destiny positively.
Aesthetic plastic surgery (cosmetic surgery) strives to achieve the highest possible harmony between dif- ferent parts of the body and the whole body, between face and body, also between anatomy and psychology, between body and soul. Harmonia suprema lex. About half of all operations are performed on the face and the other half on the body. Any surgeon performing aesthetic (cosmetic) operations has to possess psycho- logical knowledge, empathy, a high level of ethic in- tegrity, but also the forming talent of an artist.
Aesthetic surgery rests on five pillars: science, psy- chology, handicraft, art, and business. The plastic
surgeon should be able to identify the wishes of the patient, to define his/her problem and to realize the wishes of the patient in the operating theatre and not his/her own ideas of anthropometric perfection.
Plastic surgeons learn their operating technique from their surgery teachers, but we learn the rules of anthropometric harmony from sculptors – from Phi- dias, Praxiteles, Michelangelo, Leonardo, Rodin, Dalí – and also from countless painters. The artists have established the rule of sevenths applicable to the whole body, but also to the face. Boticelli’s Venus is a good example: hair is the upper seventh, the forehead is two sevenths, the nose is two sevenths, the distance be- tween the nose and the mouth is another seventh, and the last seventh is from the mouth to the chin. The ancient Greek painter Zeuxis (fifth to fourth century
Fig. 9.2. a Our patient in the studio of contemporary German artist Ingrid Bickenbach with her modern painted portraits:
“before” and “after”. Her painted look b before and c after – she does look fresh and youthful
Fig. 9.3. a We have made plaster masks of her face to get the three-dimensional proof of what we have achieved; it took more time than the entire surgery. Plaster masks of her face b before and c after
b.c.) used faces of different women to create his fa- mous portrait of Helen the beautiful. For her beauty’s sake, the Trojan war became inflamed.
Umberto Eco wrote the wonderful Storia della Bellezza (History of Beauty) which we recommend as supplementary reading. Eco starts with quotation of Hesiods story of the wedding of Kadmos and Harmo- nia. The muses present sang hotti kalón, phílon estí
“who is lovely has been beloved, who is not lovely has not been beloved”. The ancient Greeks had an expres- sion which unifies the harmony of body and soul kalokagathía to be found in the verses of Sappho and the sculptures of Praxiteles. The superb ancient Greek ideals of beauty are harmony, proportions, symmetry, eurhythmy, and analogy.
Eco writes the whole history of beauty on the basis of the works of sculptors, painters, philosophers, and poets because they were the only witnesses of beauty trends and their creators.
The medieval ideal of beauty was inspired by the mathematical beauty of the universe. Thomas Aqui- nas proclaimed his beauty ideals: proportions, com- pleteness, clarity, and brightness. Chroma – the co- lours – would be the cause of beauty. In the Middle Ages the priests forbade all means for beautification.
In the Renaissance the human being was in the mid- dle of universe and the attributes of beauty were charm and sensuality. During Mannerism there were ars geometrica and homo melancholicus (geometric art and melancholic humans) – Leonardo da Vinci, Albrecht Dürrer, and Sandro Boticelli tried to show the beauty of the spirit which was shining through
both an image maker and the image itself. Marina Abramović and her partner Ulay force visitors of their
“Imponderabilia” to body-touch and to chose the male or female principle at the entrance. Sabine Runde describes the “body as a temple”.
Religious values and family importance are dimin- ishing – our body becomes the last refuge. That is why fitness centres, the cosmetics industry, beauty spas, and cosmetic surgery are booming. We live in the age of the body cult, not only of new body consciousness.
Plastic surgeons are not the trendsetters, but are very careful observers.
Cosmetic surgery treats those body areas which are visible to everybody. That is the reason why lay- men judge not only the result of our treatment but also the indications: should something be operated on or not. We are thus obliged to enter dialogue with public opinion.
Bernd Guggenberger writes that good-looking stu- dents receive better grades for equal performances than less attractive ones, and handsome criminals get less severe punishment for the same offences than ugly criminals. Our outward appearance is a social phenomenon and not only a self-image. It is the image that others make of us and we are influenced by their reaction towards us. “Beauty promises happiness”, says Stendhal. Our pleasant appearance is not a pur- pose in itself, but it is an instrument to offer more chances in social and professional competition. Ac- cording to Charles Darwin’s theory of natural selec- tion, beauty is also the principle of sexual choice.
Among animals, the male specimen is more beau- tiful than the female (lion, deer, rooster, etc.). Beauty in animals indicates strength and determines leader- ship. The poet would say: “ Even among flowers there is no justice.” William Hogarth admits, however, that the human female body is more beautiful than the human male body because of its sinuous silhouette (clepsydra figure).
It is a great pleasure and privilege that plastic sur- geons are often invited to the studios of the artists who are working there, because many of us are very fond of fine arts, some of us paint, sculpt, or make
Fig. 9.4. The lines by the Irish poet Yeats are spoken from with- in this sculpture by the Mexican sculptor Bustamante: “I am looking for the face I had, before the World was made.”
films. We can exchange our ideas. For instance, the mouth of a human being is of the same length as the distance between the pupils of the eyes. This fact cre- ates difficulties for most beginner portrait artists.
Portrait paintings used to give the illusion of eternity through the promise of triumph over being forgot- ten.Things have changed since Louis Daguerre in France found out in 1837 how to fix the picture to pa- per. Photography is cheaper and more “democratic”
than oil-painted portraits. It is important how to illuminate the photographed face. The Rembrandt
Fig. 9.5. Andy Warhol made his “before” and “after” in 1961.
Any plastic surgeon could provide many better examples.
But, since March 2006 it has been forbidden by German law to show pictures of patients “before” and “after”! This picture was taken in March 2004 when the Museum of Modern Arts in New York was a guest in Berlin
effect with a classical look is 45° oblique from above left or right. The “butterfly effect” with illumination from straight above gives a glamorous look. Illumina- tion from below produces a startled look – it is rather undesirable.
More and more often plastic surgeons are invited to museums to give presentations of their interpreta- tion of beauty and arts. After having been invited to Frankfurt’s Museum for Applied Art in 2003, I was invited, in spring 2004, together with contemporary French artist Miray Orlan to the New York Museum of Arts and Design. Miray Orlan presented her “Car- nal art” and my part was “Anthropo-design: aesthetic surgery is becoming human applied art”.
I am deeply thankful for the opportunity to up- grade my profession to the level of other arts, for the privilege of being allowed to enter their “temples” of arts, for being accepted into the extended family to- gether with other artists. There is a fundamental dif- ference between an artist and a plastic surgeon. The artist (painter, sculptor, installer) has only to think of himself/herself and to follow his/her inner voice, without compromising for public taste. The plastic surgeon, on the other hand, has to forget himself/her- self, and always aim to satisfy the patient, not neces- sarily the criticism of his/her colleagues.
High-tech achievements make the success of our treatment more and more probable and reduce the re- covery time and the rate of complications. Worth mentioning are endoscopy, radiofrequency surgery, lasers, ultrasound-assisted liposuction, tissue glue, etc. Most operations nowadays are performed under intravenous sedation on an outpatient basis. But there
Fig. 9.6. a Miray Orlan performs as “Carnal art” seventh surgery to create her “composite autoportrait” b consisting of eyebrows of da Vinci’s Mona Lisa, the chin of Boticelli’s Venus, some mosaic stones of Europe, Diana, Psyche, etc.
is a problem: technical development is faster than our ability to work out ethical consequences. Many things are possible, but the question arises: Can it be morally justified? Is the virtual world running into the cyber- age without pause for thought? Is the creature trying
Fig. 9.7. Former Miss World: Beauty is the glittering of the indescribable (D. Panfilov)
For me, the human being is still the greatest won- der of this world. Let me end this with a quotation by Anton Pawlowitch Chekhov: “Everything concerning the human being should be beautiful – not only the face and clothes, but also one’s thoughts and ac- tions.”
Bibliography
Please see the general bibliography at the end of this book.
